Non-irrigation Group Research Articles

Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children

Nasal irrigation has been used as adjunctive therapy for sinonasal disease but is under-researched in children. The study aim was to evaluate the effectiveness of nasal irrigation with normal saline in the management of acute sinusitis in atopic children. We enrolled 60 atopic children with acute sinusitis, of whom 29 received nasal irrigation with normal saline and 31 did not receive nasal irrigation. All participants underwent a nasal peak expiratory flow rate (nPEFR) test, a nasal smear examination, and radiography (Water's projection) and were requested to complete a Pediatric Rhinoconjunctivitis Quality-of-Life Questionnaire (PRQLQ) during the baseline visit. All participants were requested to record symptoms in a daily diary and were followed up at 1-week intervals. A physical examination, nasal smear, and nPEFR were performed at each visit, and all daily diaries were collected. At the final visit (after 3 weeks), the symptom diaries were reviewed and participants were requested to complete the PRQLQ again. nPEFR, radiography, and a nasal smear were also repeated. There were significant improvements in mean PRQLQ and nPEFR values (p < 0.05) for the irrigation compared to the non-irrigation group. There was no significant difference in radiographic findings between the groups (p > 0.05). The irrigation group recorded significant improvements in eye congestion, rhinorrhea, nasal itching, sneezing, and cough symptoms compared with the non-irrigation group. Nasal irrigation is an effective adjunctive treatment for acute sinusitis in atopic children.

Abstract 615: Renal Sympathetic Denervation: A Comparison Of Irrigated And Non-irrigated Radiofrequency Ablation In A Porcine Model

Introduction: Renal artery sympathetic denervation using radiofrequency (RF) energy has recently been shown to reduce blood pressure in patients with hypertension. However arterial damage is required to achieve denervation, which has unknown long term consequences. Alternative techniques of denervation that minimize arterial wall damage are therefore preferable. We compared the ability of irrigated RF vs. non-irrigated RF to ablate the nerve fibers with respect to the degree of arterial wall sparing in an in vivo model. METHODS: Percutaneous femoral arterial access was obtained in 14 adult swine and renal angiography was performed to assess for stenosis at baseline and at time of sacrifice . Irrigated (3.5mm tip/30cc) and non-irrigated RF (3.5, 4mm and 2mm tips) energy was delivered bilaterally using custom catheters. All animals were then recovered and survived for 30-90 days. Renal cortical tissue was collected from bilateral kidneys for norepinephrine levels prior to sacrifice. Results: There was no significant interval renal artery stenosis. Arteries were sequentially sectioned, processed, cut at 4-6 μm and stained with hematoxylin&amp;eosin and movat pentachrome. Arterial medial injury (percentage depth) and nerve injury were then scored on a incremental scale of 0-4. Medial injury was significantly less in the irrigated group vs. non-irrigated group (1.15vs 2.2 p&lt;0.05). Nerve injury on the other hand was similar in both groups (1.75 vs. 1.24,p=0.24). Norepinephrine levels were obtained in 11/14 animals. In the irrigated and non-irrigated arms there was a 67% and 53% reduction of norepinephrine levels compared to that of controls. Conclusions: Irrigated RF ablation is an efficacious and feasible means to achieve renal denervation. Although medial injury occurred in both groups, irrigated RF demonstrates a lower degree of medial injury for similar levels of nerve injury when compared to non-irrigated RF.

Heat Generation by Two Different Saw Blades Used for Tibial Plateau Leveling Osteotomies

During tibial plateau leveling osteotomy (TPLO) the saw blade produces frictional heat. The purpose of this study was to evaluate and compare heat generated by two TPLO blade designs (Slocum Enterprises [SE] and New Generation Devices [NDG]), with or without irrigation, on cadaveric canine tibias. Thirty-six paired tibias were used to continuously measure bone temperatures during osteotomy through both cortices (i.e., the cis and trans cortices). Each pair was assigned to either an irrigation or nonirrigation group during osteotomy, and each tibia within a pair was osteotomized using a different saw blade design. Saw blade temperatures were recorded and temperatures were compared for all combinations of blade type, cortex, and irrigation. In the cis cortex group, the SE blade generated more bone heat than the NGD blade (P=0.0258). Significant differences in temperature generation between saw blade types were seen only when the osteotomy site was not irrigated (P=0.0156). For all variables measured, bone and saw blade temperature generation was lower with irrigation (P<0.05). None of the osteotomies performed with either saw blade produced a critical duration of damaging temperature ranges in this study. Although saw blade design and irrigation influence heat generation during the TPLO, the potential for bone thermal damage during TPLO is low. The use of the NGD blade with irrigation is recommended.

The effect of dehydration and irrigation on tendon adhesion formation after tendon exposure

The aim of this study was to evaluate the effects of dehydration due to tendon exposure on adhesion formation on the tendon surface. Achilles tendons of 60 New Zealand white rabbits were surgically exposed and evaluated. In the control group (Group 1), the wound was closed immediately; and in the remaining two groups, Achilles tendons were exposed to air for 60 minutes without (Group 2) or with (Group 3) regular saline irrigation. After undergoing clinical examination, 50% of rabbits in each group were sacrificed 3 weeks postoperatively and 50% at the 6th postoperative week. All tendons exposed to air exhibited mild or moderate degrees of adhesion. Compared to the control group, the incidence of adhesion formation was significantly higher in the groups where tendons had been exposed to air for 60 minutes, whereas no significant difference was found between the irrigated and non-irrigated groups. No limitations or contractures were detected in the hind limbs of the animals at the clinical examination. Regardless of irrigation, tendons are not prone to form clinically apparent adhesions during operations under 60 minutes of duration.

Comparison of Catheter Ablation Results between Irrigated and Nonirrigated Ablation Catheter in Patients with Atrial Fibrillation

Aims: The relative efficacy of open irrigated tip catheters compared with conventional non-irrigated catheters for catheter ablation of atrial fibrillation (AF) is unknown. Methods: A total of 501 consecutive AF patients (age: 55 years, 453 males paroxysmal AF: 264 and persistent AF: 243) was included in the present study study. Catheter ablation was performed with using open-irrigated and non-irrigated 8 mm catheters in 265 and 236 AF patients, respectively. Pulmonary veins (PVs) were isolated in all patients. The supplemental ablation, involving the electrogram-based ablation (n=148) or/and the linear ablation (n=134), was performed in persistent AF. Results: The success rates of PV isolation, electrogram-based ablation (termination of AF), linear ablation (bi-directional block) did not differ between 2 groups. The duration and amount of radiofrequency energy delivery for PV isolation (1252±656 vs. 2171±1128 seconds, P<0.01 and 33485±17135 vs. 56118±28864 J, P<0.01), electrogram-based ablation (1072±920 vs. 2069±1729 seconds, P<0.01 and 30213±27477 vs. 49313±40479 joules, P<0.01) and linear ablation (1171±470 vs. 1413±550 seconds, P=0.02 and 36730±14400 vs. 43340±18141 joules, P=0.04) were significantly shorter in irrigation group compared to non-irrigation group. Conclusion: Although 8 mm non-irrigated ablation catheter was equivalent to irrigated catheter for AF ablation, using an irrigated ablation catheter reduced the radiofrequency energy achieving the endpoint of AF ablation.

Nasal Irrigation Reduces Postirradiation Rhinosinusitis in Patients with Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. Radiotherapy (RT) is the standard treatment for NPC. The newer RT technique, intensity-modulated radiotherapy (IMRT) has become popular in recent years. IMRT-induced rhinosinusitis is not uncommon in postirradiated NPC patients but the incidence and the disease course have not been reported. The purpose of this study was to determine the IMRT effect on the paranasal sinuses and evaluate the efficacy of nasal irrigation on the management of RT-induced rhinosinusitis. NPC patients who completed IMRT from October 2004 to May 2006 were enrolled in the study and were randomly allocated to irrigation or nonirrigation groups. Patients in the irrigation group performed daily nasal irrigation until 6 months after RT. The severity of postirradiated rhinosinusitis was evaluated by nasal endoscopy, questionnaire, and computed tomography until a year after RT. One hundred seven postirradiated NPC patients completed the study. Among them, 44 patients performed daily nasal irrigation until 6 months after RT, and the other 63 patients did not perform nasal irrigation after RT. Patients in the irrigation group had significantly lower endoscopic and questionnaire scores than patients in the nonirrigation group (p = 0.001 and 0.0001, respectively) from pre-RT to 6 months after RT. The between-group differences were most obvious at the post-RT second and third months. Rhinosinusitis is a common acute post-RT complication in NPC patients. Our results showed that nasal irrigation was a safe and effective method for the management of this acute complication.

Abstract 3225: Ablation Of The Pulmonary Veins Using An Irrigated Tip Rf Ablation Catheter Reduces Cerebral Microemboli Versus A Non-irrigated-tip Rf Ablation Catheter.

Background Pulmonary vein isolation (PVI) has become an established treatment for patients with atrial fibrillation (AF). But post-intervention complications like, TIA, stroke and cognitive decline, might occur. In this study the incidence of microembolic signals (MES) was determined during percutaneous PVI; non-irrigated tip radiofrequency (RF) ablation versus irrigated tip RF ablation. Methods and Results Twelve patients underwent PV catheter RF ablation. Two patient groups were selected; Group NON-IRRIGATED RF: a non-irrigated RF ablation catheter (temperature&lt; 55°, power&lt; 30 W) was used in 7 patients, Group IRRIGATED RF: an irrigated tip RF ablation catheter (temperature&lt; 43°, power&lt; 25 W) was used in 5 patients. Transcranial Doppler (TCD) was used to detect microembolic signals in the middle cerebral arteries. The duration of the procedure, the number of applications and the total ablation time was not different between both groups. In the IRRIGATED RF group versus the NON-IRRIGATED group less cerebral MES were detected during the complete procedure (1570 vs. 3515) and per 1 minute of ablation (4 vs.89). Conclusions Ablation of the pulmonary veins in a percutaneous endocardial approach causes a significant number of cerebral MES during the procedure. The cerebral MES detected during ablation are most likely gas bubbles and solid emboli due to overheating of the tissue and blood. Because a positive association between the number of cerebral MES and the risk of stroke and neurological impairment has been reported, the RF irrigated tip ablation catheter might be preferable in an effort to reduce the stroke risk. Number of MES during irrigated and non-irrigated PVI

The Saline Irrigation Effect Using Closed System Drainage on Chronic Subdural Hematoma

Objective: Though the treatment using burr hole trephination in chronic subdural hematoma (CSDH) is simple and effective, but recurrence is not a few and the appropriate method of drainage is still controversial. We retospectively reviewed recurrence of CSDH, complete resolution rate and occurrence of postoperative complication between two groups: closed drainage group after saline irrigation and closed drainage group without saline irrigation. Methods: Between January 2004 and June 2006, fifty five patients who had taken operation using burr-hole in unilateral CSDH were divided into two groups. Twenty eight patients (group A) were drained hematoma after saline irrgation and twenty seven patients (group B) were inserted catheter after dural incision immediately without saline irrigation. All catheter were placed frontal area and the catheter was removed postoperative second day. Results: There were 4 recurrence of hematoma (14.3%), 8 postoperative pneumocephalus (28.6%) in group A and 3 recurrence (11.1%) and 6 pneumocephalus (22.2%) in group B. The total resolution of hematoma rate was 45.8% in group A and 58.3% in group B within postoperative seven days. All patients were resolved totally until postoperative one month except one patient in group A. Postoperative complication including postoperative seizure, infection and tension pneumocephalus was not occured in all patients. Conclusion: The saline irrigation is not decreased the recurrence rate and resolution rate compare to non-irrigation group. So, saline irrigation is not needed in CSDH operation using burr-hole and closed-system drainage. (J Kor Neurotraumatol Soc 2007;3:25-28)

Protective effects of cisternal irrigation on leptomeningeal and cortical structures in meningitis: An experimental study

Meningitis, termed as foreign material collection in the subarachnoid space, leads to various meningeal, cerebral and spinal cord pathologies. Meningitis still remains a problematic disease with severe complications in spite of advanced medical technology. In this study, we aimed to investigate the role of cisternal irrigation in the prevention of meningitis complications. SETTING AND STUDY DESIGN: Experimental study was done in the Social Security Hospital of Erzurum. Histopathological specimens were evaluated in the Pathology Department in the Ataturk University Research Hospital, Erzurum, Turkey. This study was conducted on twelve lambs. Experimental meningitis was achieved with streptococcus pneumonia. Two animals were not treated. Ten animals were given Cefotaxime (4 x 1g/day) for 20 days, and additionally half of these animals underwent cisternal irrigation. Then, all animals were sacrificed and brains were observed histopathologically. Massive purulent CSF formation, hemorrhagic cortical lesions, vascular congestion, leptomeningeal and cortical adhesions and brain edema were observed in the non-irrigated group, but these findings were observed slightly or absent in the irrigated group. Meningitis can affect all central neural tissues, consequently serious central nervous system lesions may develop. The irrigation procedure may decrease the percentage and severity of meningitis complications by way of the excretion of inflamed purulent collection from the subarachnoid spaces.

Measurements of drill-induced temperature change in the facial nerve during mastoid surgery: a cadaveric model using diamond burs.

The purpose of this study was to investigate the changes in temperature in the facial nerve that occur during mastoid drilling by the facial recess approach and to confirm the beneficial effects of constant irrigation while drilling. Mastoid drilling was performed on human cadaveric temporal bones by means of 4-mm diamond burs with and without irrigation. There were 6 subjects in each group. Changes in facial nerve temperature were recorded on a continuous-output monitor. Significant changes were found in temperature for both the irrigation and non-irrigation groups (p < .0001). Constant irrigation minimized the rise in temperature. Facial recess drilling poses a potential threat to cranial nerve VII via thermal injury. The temperature elevation in the non-irrigation group was significantly greater than that in the irrigation group and was greater than the tolerable limits of peripheral nervous tissue. This finding supports the need for constant irrigation during the approach to the facial recess in mastoid surgery.

Irrigation in Facial and Scalp Lacerations: Does It Alter Outcome?

Study objective: Animal and human studies suggest that irrigation lowers the infection rate in contaminated wounds, but there is no evidence that this common practice is beneficial for “clean” lacerations. We tested the null hypothesis that there is no difference in the infection rate for noncontaminated lacerations to the face and scalp that are irrigated before primary closure compared with similar wounds that are closed primarily without irrigation. Methods: We performed a cross-sectional study of consecutive patients presenting to a suburban, academic emergency department between October 1992 and August 1996. Patients with nonbite, noncontaminated facial skin or scalp lacerations who presented less than 6 hours after injury were included. Structured, closed-question data collection instruments were completed at the time of laceration repair and at suture removal. The primary outcome parameters were the incidence of wound infection and the short-term cosmetic appearance of lacerations in patients who did or did not receive irrigation. Results: A total of 1,923 patients were included in the study group; 1,090 patients received saline irrigation, and 833 patients did not. The irrigation and nonirrigation groups were similar with regard to time from injury to presentation (1.56 versus 1.42 hours, respectively), frequency of linear wound morphology (82% versus 88%), frequency of smooth wound margins (72% versus 82%), number of layers of closure (1.14 versus 1.26), number of skin sutures applied (4.98 versus 4.65), number of deep sutures applied (.70 versus 1.05), and use of oral antibiotic prophylaxis (2.8% versus 4.0%). With respect to outcomes, the incidence of wound infection was not significantly different between the two treatment groups (.9% versus 1.4%, respectively; P=.28). Likewise, the percentage of patients who had an “optimal” cosmetic appearance was similar in the two groups (75.9% versus 81.7%, respectively; P=.07). Conclusion: Irrigation before primary closure did not significantly alter the rate of infection or the cosmetic appearance in our study population with clean, noncontaminated facial and scalp lacerations. [Hollander JE, Richman PB, Werblud M, Miller T, Huggler J, Singer AJ: Irrigation in facial and scalp lacerations: Does it alter outcome? Ann Emerg Med January 1998;31:73-77.]

Effects of acid rain on growth and nutrient concentrations in Scots pine and Norway spruce seedlings grown in a nutrient-rich soil

The effects of artificially applied acid precipitation on growth and nutrient concentrations of Scots pine ( Pinus sylvestris L.) and Norway spruce ( Picea abies [L.] Karst.) seedlings were investigated in a long-term acid irrigation experiment in field conditions. Seedlings of northern and southern origin were planted in boxes containing peat and composted soil rich in nutrients, and sprinkler irrigated with water acidified with nitric and sulphuric acids to pH 3 or pH 4 for periods varying from two to three and a half growing seasons during 1986–1989. Water irrigated (pH 5.4–7.6) and non-irrigated groups of seedlings were also included in the experiment. At the end of the experiment needles, main and lateral shoots and roots were collected from the seedlings for the determination of height growth and biomass partitioning, and for the analysis of S, N, Mg, P, K, Ca, Mn and Fe concentrations. The treatment effects compared to the irrigated control were studied using multivariate analyses of variance and covariance. In the pine seedlings the total dry matter production increased by 25–70% compared with the irrigated controls when the total wet deposition to the seedlings exceeded 67 kg S ha −1 and 36 kg N ha −1 (e.g. after two growing seasons' exposure of the pH 3 treatment). The increase was mainly due to an increase in needle dry weight (54–72% greater at pH 3) and root weight (20–65% greater at pH 3), whereas the height growth or shoot weight growth were less affected. The northern provenance pine seedlings responded more clearly to the pH 3 irrigation than the southern ones. The treatments had no consistent effects on any of the growth variables studied in the spruce seedlings, however. The pines had higher root and foliage Ca concentrations as a result of the acid irrigation, whereas in spruce, acid rain decreased the Ca concentration in needles and shoots. Root Mn and Fe concentrations were higher in both species as a result of the pH 3 treatment. A higher soil conductivity and Ca concentration resulted from the prolonged pH 3 treatment. The results strongly support the hypothesis that the long-term growth and nutrient allocation response of conifers to acid precipitation is dependent both on the tree species and on the nutritional status of the soil.

Effect of Ringer's Lactate Irrigation on the Formation of Postoperative Abdominal Adhesions

Intraabdominal adhesions continue to pose a potentially serious postoperative clinical problem. Reported here is an experiment designed to study any effect that balanced Ringer's lactate (RL) solution may have on intraabdominal adhesion formation. Surgical trauma was induced in mice by controlled gauze abrasion of one side of the abdominal wall; the opposite side was used as a control. RL irrigation was compared with no irrigation. Adhesions were scored on the basis of incidence (%) and severity (on a 0-10 scale). The abraded right peritoneum exhibited 100% adhesions for both the RL group and the nonirrigated group. However, on the side that was not abraded, the nonirrigated group showed only 30% incidence of adhesions and 1.7 +/- 3.3 severity as compared with 100% adhesions and 7.7 +/- 2.2 severity for the RL group. These results suggest the need for further studies to establish the extent to which irrigation with solutions such as Ringer's lactate or saline may enhance formation of postoperative adhesions.

An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic.

From June 1978 through December 1980, at least 36 cases of amebiasis occurred in persons who had had colonic-irrigation therapy at a chiropractic clinic in western Colorado. Of 10 persons who required colectomy, six did. Of 176 persons who had been to the clinic in the last four months of 1980, 80 had received other forms of treatment. Twenty-one per cent of the colonic-irrigation group had bloody diarrhea, as compared with 1 per cent of the non-irrigation group (P = 0.00013). Thirty-seven per cent of the colonic-irrigation group who submitted specimens had evidence of amebic infection on either stool examination or serum titer, as compared with 2.4 per cent in the non-irrigation group (P = 0.00012). Persons who were given colonic irrigation immediately after a person with bloody diarrhea received it were at the highest risk for the development of amebiasis. Tests of the colonic-irrigation machine after routine cleaning showed heavy contamination with fecal coliform bacteria. The severity of disease in this outbreak may have been related to the route of inoculation.